During laparoscopy, a minimally invasive surgical procedure in which tissue for example may be removed from the abdomen or chest through a small puncture wound, the laparoscopic surgery is performed with the aid of an endoscopic camera. The camera is placed through a port in the skin into a working cavity and may be used for example to visually examine the interior of the cavity such as the peritoneum or surgical planes or spaces created for purposes of dissection. Typically, the camera includes a light source. Correct positioning and aim of the laparoscopic camera and light throughout a procedure are fundamental to laparoscopy.
Most commonly, the endoscopic camera is held by an assistant who must continually watch the video monitor and hold a steady position until the surgeon requests a change in the field of view. Alternatively, a variety of robotic arms have been designed to hold the camera and move for example on voice command by the surgeon. Such systems include the AESOP® (Automated Endoscopic System for Optimal Positioning) voice controlled robot system and the Zeus® minimal invasive surgical robot system from Computer Motion Inc./Intuitive Surgical Inc. Mechanical/electrical servomotor controlled systems that move by foot controls, palm and fingertip controls include the LAPMAN® by MedSys s.a. of Belgium, while a remote, manual control system da Vinci® is available from Intuitive Surgical Inc.
In addition, a variety of known mechanical frameworks that have multiple adjustment and locking points can be used to hold an endoscopic camera including a laparoscopic retractor from Thompson Surgical Instruments, the Martin Arm System from Gebrüder Martin GmbH & Co. KG, and the Omni-Tract® surgical retractors from Minnesota Scientific Inc. These devices have the capability of holding other laparoscopic instruments as well, although different connections at the instrument interface may be required depending on the instrument and the application.
The first choice for any surgeon is to have a good human assistant, who can continuously and accurately aim and focus the camera and light on the moving surgical field. Unfortunately, good assistance, or any assistance for that matter, is frequently unavailable, and the surgeon must work solo. Also, occasions frequently arise where an assistant's hands may be occupied by other tasks, such as retraction and suction, and in these circumstances other means for holding the camera also are required. The alternatives for holding and positioning the camera cited above then come into play. However, these alternatives each have one or more troublesome drawbacks. The high end robotic arms (such as da Vinci) are expensive, have high maintenance requirements, are time consuming and cumbersome to set up and may have high cost disposable components. They also require an experienced assistant or technician to be present. The simpler, voice controlled (AESOP) or palm radio controlled (LAPMAN) robotic arms also require significant maintenance and set up time, move too slowly for many surgeons, and are hard to precisely control. The mechanical arms and frameworks that are available typically have too many movable parts that require adjustment, require two hands for re-positioning, may have a large footprint near the surgical field, and are very slow to re-position because of the several joints that must be loosened and retightened.
Thompson Surgical Instruments also offers a Flexbar Scope Holder (product #42133C). This device has a clamp to the bedside railing and a set of stainless steel rods that may be clamped at a desired length with right angle clamps to position the base attachment of a curvilinear flexible arm. The arm uses a combination of a screw and cam locking mechanism to achieve an adjustable friction lock of the arm. In this device, the clamp that holds the laparoscopic camera at the free end of the flexible arm has limited capabilities; the clamp becomes locked dimensionally with the arm and is not a universal joint. The design of the scope holder generally requires a user to loosen and then retighten the locking mechanism for the arm whenever it is necessary to reposition the laparoscope.
Thus, there remains a need for better holding and positioning devices for laparoscopic instruments in general and for the laparoscopic camera (laparoscope) in particular. In particular there is a need for a device that will hold a laparoscope steady when it is not in hand, may be quickly re-positioned using one hand, allows quick engagement and disengagement to a laparoscopic instrument, and has a minimal and movable footprint on the surgical field.